Delirium Tuesday March 17 2015 9 25 PM 1 Identify the various stages of consciousness in a patient admitted to the ICU using a validated assessment tool such as the Riker sedation agitation scale SAS a Riker Sedation Agitation Scale i ii iii iv v vi vii 7 Dangerous Agitation Pulling at endotracheal tube thrashing 6 Very Agitated Requiring restraint biting 5 Agitated Anxious or physically agitated calms to verbal instructions 4 Calm and Cooperative Calm easily arousable follows commands 3 Sedated Difficult to arouse but awakens to verbal stimuli or gentle shaking follows simple commands but drifts off again 2 Very Sedated Arouses to physical stimuli but does not communicate or follow commands may move spontaneously 1 Coma Unarousibility Minimal or no response to noxious stimuli does not communicate or follow commands 2 3 Differentiate delirium from dementia Identify delirium in a verbal patient outside the ICU using the confusion assessment method CAM a Presence of 1 and 2 and either 3 or 4 i ii iii iv Acute Onset Inattention Disorganized thinking Altered level of consciousness 4 Identify delirium in a non verbal patient in the ICU using both the Confusion Assessment for the ICU and the Intensive Care Delirium Screening Checklist ICDSC a CAM ICU i Presence of 1 and 2 and either 3 or 4 Acute onset or fluctuating mental status Inattention a SAVEAHAART squeeze hand when A is said Disorganized thinking Altered level of consciousness a Use sedation score b Intensive Care Delirium Screening Checklist ICDSC i ii Scored 0 8 A total score 4 has a correlation for delirium Altered level of consciousness Inattention Disorientation Hallucinations or Delusions Psychomotor Agitation or Retardation Inappropriate Speech or Mood Sleep Wake Cycle Disturbance Symptom Fluctuation 1 2 3 4 1 2 3 4 5 6 7 8 5 Differentiate mild cognitive impairment from dementia a Mild cognitive impairment the stage between normal forgetfulness due to aging and the development of dementia and will present as i ii iii iv Forgetting recent events or conversations Difficulty performing more than one task at a time Difficulty solving problems Taking longer to perform more difficult mental activities 6 Screen a patient for dementia using the abbreviated mental test score AMTS Test 2 Page 1 6 Screen a patient for dementia using the abbreviated mental test score AMTS a b A score of 6 or less suggests delirium or dementia Need to know if acute or chronic to differentiate from delirium and dementia 7 Interview a close friend or family member using the Informant Questionnaire on Cognitive Decline in the Elderly IQCODE to determine if their friend or family member has dementia Risk Factors for Delirium Anticholinergics corticosteroids and benzodiazepines could increase the chance of developing delirium Test 2 Page 2